Rural-urban divide impacts patients seeking specialists

Experts have identified huge discrepancies in access to breast reconstruction surgery, between rural and urban areas, and between various regions of Canada.

Photograph by: Archive
, Calgary Herald

Geographical barriers to health care is a common problem in Canada, where most doctors and specialists practise in cities rather than rural areas.

But for breast cancer patients seeking reconstructive surgery, there is a “huge discrepancy” in access depending on where a woman lives in the country, said Dr. Toni Zhong, a plastic surgeon at the University Health Network in Toronto who is researching the issue.

For example, a 2005 study revealed that during the mid-1990s breast reconstruction in Toronto, with 10 reconstructions per 100 mastectomies, took place more than twice as often than in the rest of Ontario, with 4.3 reconstructions per 100 mastectomies. The numbers are outdated, but Zhong said she thinks the gap still persists to some degree.

Dr. Sheina Macadam, a plastic surgeon in Vancouver, said she sees many patients who travel from remote areas who weren’t offered reconstruction at the time of their mastectomy.

“I think a lot of it has to do with the difficulty of organizing a consult in Vancouver in a timely fashion, because these women need to have their mastectomies,” said Macadam. “If there’s no plastic surgeon in your community, chances are you’re not going to get reconstruction.”

Fellow Vancouver plastic surgeon Dr. Nancy Van Laeken said she also gets patients who travel not only from remote corners, but even some major urban centres such as Calgary and Edmonton, who were not offered immediate reconstruction.

“They’ve gone online to get information,” she explained. “And it doesn’t take the educated patient long to figure out that there’s an option that should be made available to them.”

Dr. Steven Morris, a plastic and reconstructive surgeon in Halifax, said breast cancer patients in rural areas are forced to decide whether it’s important to have a mastectomy in a timely fashion, or wait for a referral to a different surgeon who works with a plastic surgeon.

“That process selects who would pursue reconstruction,” he said. “And it’s not for everybody, because it’s a lot more hurdles to jump over to get to that operative procedure.”